This article contains an insight provided primarily focusing on the difference between the outdated concepts and the modern dentistry, in terms of root caries.
By Dr Sumaiya Hasan
With the innovative advancement in Restorative Dentistry, a number of 'non-restorable' teeth are being saved now by dentists around the globe.
A chief example of non-restorable include teeth which have been affected significantly by caries or trauma to an extent that the cavosurface margin lies subgingival or subcrestal
Such cases may include root caries, which is considered notoriously challenging, by the dentist, in terms of treatment plan and protocols. Undoubtedly, the reasons for this are manifold and not in the scope of this article. However, pertinent points are discussed in this article for an overview.
What is Root Caries?
A number of similar definitions of root caries have been quoted in different articles from renowned journals. It is soft irregularly shaped lesion. Usually confined to root surface or involving the undermining of enamel at the cementoenamel junction. However, clinically indicating that the lesion initiated on root surface.
What makes it challenging?
A multitude of factors have a profound impact on the restoration of root carious lesions. While its location is the principal problem, the fact that it has exceedingly high incidence in elderly population intensifies this problem. This is due to the fact that,
- In some areas of world, aged patients may not have access to dental care or may not be compliant enough to acknowledge and thoroughly understand the critical nature of this problem. Even if they do receive the dental care, many of them, due to the debilitated health, may not be able to maintain their dental health post-operatively.
- Advancing age could be an aggravating factor that increases the susceptibility for root caries, particularly with history of ongoing periodontal disease. This interplay between periodontal disease and root caries may potentially act as a double edged sword for the restorative dentist.
What's new?
In the course of preventing and treating root caries, dental research has been accelerating to bring forward techniques and equipment. This can bring ease for the operator and the patient. At the same time, it can also enhance the prognosis of the treatment. While few such advances have even started being applied to facilitate clinical practice, others are still being investigated via research. Few examples include,
1. Enhancing remineralisation of lesion by,
- Adding calcium sodium phosphosilicate bioactive glass to fluoride dentrifice
- Calcium and phosphate ions at high concentration stabilised in nanocomplex CPP-ACP
- Acidulated phosphate fluoride gel
2. Secondly, preventing root caries via fluoridated sealants such as fluoride-containing resin based desensitising agents
3. Application of cross linkers on root surface to decrease proteolysis in root caries.
4. Application of collagenase inhibitors.
5. Also, application of antibacterial agents such as silver diammine fluoride.
6. Surface modification with lasers
7. Incorporation of antibacterial and remineralising component into adhesive system
8. Moreover, techniques such as deep marginal elevation to restore cavities with subgingival margins
9. Minimally invasive perioplastic microsurgery for aesthetic crown lengthening
10. 3D printed surgical guide for crown lengthening
Conclusion:
Dental research is pacing forward swiftly. Subsequently, it has made it possible what previously seemed impractical in clinical practice.Clinicians around the globe are optimistic in terms of future prospects of dentistry. Owing to the increasing life span of individuals, incidence of root caries is expected to increase. Therefore, translation of dental research into clinical practice is pivotal for the sake of quality of dental care; not just in case of root surface lesions but for other dental treatments as well.
–The author is contributing writer at Dental News Pakistan and can be reached at sumaiya.hasan3@gmail.com